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86
Public Health at
Risk
A US Free Trade
Agreement could
threaten access to
medicines in Thailand
New stringent drug patent and marketing rules being negotiated
in a Free Trade Agreement (FTA) between the US and Thailand
would limit competition and reduce access to affordable
medicines in Thailand. This would threaten the future of existing
successful Thai HIV/AIDS treatment programmes, which rely on
inexpensive generic drugs, and thus deprive thousands of
people of effective treatment. Oxfam opposes an FTA with
intellectual property rules that exceed the standards agreed at
the World Trade Organization.
Glossary
ARV: antiretroviral drugs are medicines for the treatment of infection by
retroviruses, primarily HIV. Different classes of antiretroviral drugs act at
different stages of the HIV life cycle.
Baht: Thai currency: 38 baht is roughly equivalent to $1.00, 0.80, and
0.55.
Compulsory license: a government measure that permits a patent to be
overriden so that another party (public or private) can use the patent after
paying reasonable compensation to the patent holder.
Fast Track: (also known as the Trade Promotion Authority or TPA). US
legislation that authorizes the Executive branch to negotiate trade
agreements and then bring them to Congress for a yes or no vote without
any possibility to amend them.
FTA: Free Trade Agreement.
GPO: Government Pharmaceutical Organization, a state enterprise under the
Ministry of Public Health in Thailand.
NAPHA: Thailands National Access to Antiretroviral Program for People
Living with HIV/AIDS.
NGO: Non-governmental organization.
Parallel importation: the importation of a patented drug from a third country
where its market price is lower than that in the country of origin due to the
differential pricing practice by drug companies.
RTA: Regional Trade Agreement.
TRIPS: Trade-Related Aspects of Intellectual Property Rights. The WTO
TRIPS Agreement establishes minimum levels of protection that each
government has to give to the intellectual property of other WTO members.
The agreement was included in the 1986-1994 Uruguay Round global trade
negotiations that concluded with the formation of the WTO. It applies to all
members of the WTO.
2 HIV/AIDS in Thailand
More than 1 million women, men, and children have contracted HIV
in Thailand, and more than 500,000 have died of AIDS since the
outbreak of the epidemic. In spite of successful prevention efforts,
there are still around 20,000 new infections each year. 3
Widespread transmission of HIV in Thailand occurred in the late
1980s. Between 1988 and 1989, the rapid transmission of HIV was
apparent among injecting drug-users who showed over 50 per cent
HIV prevalence in some provinces. From 1993 to 1997, 8,325 cases
were reported, but it is believed that HIV infections spread most
rapidly among sex workers. Nearly half the sex workers in Chiang
Mai, a northern province of Thailand, were infected with HIV. 4 The
high rate of infection among female sex workers led to the rapid
transmission of HIV/AIDS to their male clients, and from infected
males to their wives, partners and children.
Aggressive prevention efforts have helped to slow the spread of the
disease and it is estimated that more than 5 million infections have
been prevented as a result. 5 Nevertheless, there is evidence that
infections are growing in the general population and among specific
groups. For example, the rate of HIV infections among teenagers rose
from 11 per cent in 2001 to 17 per cent the following year. 6
Women have been heavily affected by the pandemic. At the early
stage of the pandemic, around one-third of adults living with
HIV/AIDS in Thailand were women, often infected by husbands or
7 Conclusion
Oxfam shares the concerns of Thai NGOs that a Free Trade
Agreement with the United States containing new stringent
intellectual property rules could seriously undermine future access to
affordable medicines in Thailand. Oxfam urges the United States to
stop pressuring Thailand to implement TRIPS-plus measures in the
FTA, and instead to give maximum support to Thailand to use the
flexibilities contained in TRIPS, such as compulsory licensing, in order
to expand and ensure the sustainability of the Thai AIDS program that
has successfully used generic medicines.
8 Recommendations
Thailand and the United States should halt FTA negotiations in order
to carry out and take into account independent studies on the
potential impact of proposed FTA provisions on public health.
Greater transparency is necessary throughout all FTA negotiations by
disclosing the negotiating text to the public and making it available to
all stakeholders. Furthermore, the concerns and proposals of civil
society stakeholders should be taken into account in all negotiations.
It is already clear from the leaked US negotiating proposal that the
FTA could have serious implications for public health in Thailand,
particularly in the treatment of HIV/AIDS. Before considering the
adoption of such new policies, a much broader public debate is
needed.
Any trade agreement negotiated between the United States and
Thailand should not include any TRIPS-plus measures, but rather
should expressly include in the text affirmative support for Thailands
right to use the flexibilities provided under the WTO TRIPS
Agreement, the Doha Declaration and its subsequent 30th August
Decision, known as the TRIPS/health solution. Furthermore,
Thailand should consider exercising its right to the full use of
compulsory licensing and should retain the discretion to determine
the grounds upon which it can be used. No trade agreement should in
any way serve to limit generic competition.